Elderly people living at home have less control, not more

by Norwegian University of Science and Technology

edited by Swati Mestri, reviewed by Andrew Zinin

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Today, most older people with disabilities receive help at home, and there are limited places in nursing homes. At the same time, politicians claim that living at home provides independence and control over everyday life.

The first major Norwegian study of control over everyday life among older people, however, shows something completely different.

The study has been published in the journal Age and Ageing.

"Those who receive home care services have significantly less control over their everyday lives than those who live in nursing homes or care homes," says Lisa Victoria Burrell.

Burrell is a researcher at the Centre for Care Research at the Norwegian University of Science and Technology (NTNU) Gjøvik.

Less control and meaningful activity

Researchers at the center interviewed 414 older users in three municipalities in Eastern Norway. The participants live in nursing homes, in care homes or receive home care services.

They also spoke to relatives and staff and observed residents of nursing homes and care homes with cognitive impairment.

"We wanted to look at these questions: How are the patients really doing? What do they think about their quality of life, and how much do they feel they have control over their everyday lives?" Burrell says.

The results show that:

• A third of older people who receive home care services feel they have little or no control over their everyday lives.
• Those who receive home care services have significantly poorer control over their everyday lives than those who live in care homes and nursing homes.
• They also experience less meaningful activity than older people in care homes. In other words, they are more bored.

"The paradox here is that older people who receive home care services have the best conditions for experiencing control. They are younger, have better mental and physical health, and have more contact with family and friends than those who live in care homes and nursing homes," Burrell says.

Being in control has many advantages. It supports good physical and cognitive health, prevents frailty, reduces mortality, increases quality of life and promotes good health choices.

"It is therefore a major problem that many older people who receive home care services feel they lack control over their everyday lives," Burrell says.

Unpredictable home care visits

Burrell believes one explanation is that older people's everyday lives are all about change. They have to transition from managing things on their own to being dependent on help. Now, control means being informed, listened to, respected and included in decisions about their own lives. How care is provided and who provides it thus determine their experience of control over everyday life. This kind of control also needs to be created when older people interact with home care services.

"Here, home care services can be a barrier to perceived control. Many older people living at home are frustrated by long waiting times and unpredictable visits from home care services. Their daily routines and meaningful activities are at the mercy of employees' schedules," Burrell says.

Another factor is high employee turnover, so home care providers are often unknown to their older clients.

But many older people want to live at home anyway

Many older people want to live at home for as long as possible. They are afraid of losing control and independence if they move to a nursing home. Burrell says the opposite is likely to be true.

"Older people in nursing homes experience more control than those living at home," she says.

But not everyone can live in a nursing home; municipalities cannot afford that. If older people are to thrive at home, they must feel in control of and able to manage everyday life.

"And then politicians and health authorities must stop highlighting home care services as an offering that gives seniors good control and contributes to their independence. Instead, authorities need to take measures to achieve this goal," Burrell says.

Four things in particular need to be in place:

• Employees must be given enough time to do their jobs in a caring way.
• Home care services must include users in decisions, listen to their opinions and try to comply with their wishes.
• Older people must be treated with respect and consideration by staff and municipalities.
• Municipalities must increase continuity among workers who visit the homes of the frailest older people.

Publication details

Lisa Victoria Burrell et al, Individual and interpersonal factors associated with care-related quality of life in older adults: a comparison of home-based services, nursing homes and sheltered housing, Age and Ageing (2026). DOI: 10.1093/ageing/afag039

Journal information: Age and Ageing

Key medical concepts

Home Care ServicesNursing HomesCognitive Dysfunction

Clinical categories

Geriatric palliative careHealthy aging Provided by Norwegian University of Science and Technology Who's behind this story?

Swati Mestri

Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

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